An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause.

INTRODUCTION: Women are not usually taught about the menopause formally, and many general practitioners have relatively little training. The aim of this study was to explore perimenopausal women's attitudes and knowledge of the menopause. METHOD: An online survey was designed to evaluate attitudes and knowledge of the menopause in women older than 40 years. The survey was generated with Qualtrics XM® and promoted via social media. In all, 3150 women started the survey. In this study, data from 947 perimenopausal women were analysed. RESULTS: Regarding women's attitudes to the menopause, 38.8% were accepting of it but more than 30% were dreading it. The women had experienced a number of menopause symptoms including mood swings (68.9%), brain fog (68.3%), and fatigue (66.8%). More than 90% of women had never been taught about the menopause at school, and more than 60% did not feel informed at all about the menopause. School was thought to be the best place for menopause education to start (83.6%). In all, 68.2% of women had only looked for information about the menopause as their symptoms started and they had talked to friends and used a variety of websites to look for information. When asked for their free-text views on the menopause, thematic analysis produced four themes: the overarching knowledge gap, the onset and impact of symptoms, perimenopause: the hidden phenomenon, and managing symptoms: differing schools of thought. CONCLUSION: Lack of education for women and their general practitioners is causing perimenopausal women to go through this important stage in their lives with a lack of knowledge and appropriate medical care. It is essential that women are taught about the menopause, from school onwards and that we offer health professionals appropriate training starting from the medical school curriculum.

Outcomes of domestic violence screening at an acute London trust: are there missed opportunities for intervention?

OBJECTIVES: Domestic violence screening is advocated in some healthcare settings. Evidence that it increases referral to support agencies or improves health outcomes is limited. This study aimed to (1) investigate the proportion of hospital patients reporting domestic violence, (2) describe characteristics and previous hospital attendances of affected patients and (3) assess referrals to an in-house domestic violence advisor from Camden Safety Net. DESIGN: A series of observational studies. SETTING: Three outpatient clinics at the Royal Free London NHS Foundation Trust. PARTICIPANTS: 10,158 patients screened for domestic violence in community gynaecology, genitourinary medicine (GUM) and HIV medicine clinics between 1 October 2013 and 30 June 2014. Also 2253 Camden Safety Net referrals over the same period. MAIN OUTCOME MEASURES: (1) Percentage reporting domestic violence by age group gender, ethnicity and clinic. (2) Rates of hospital attendances in the past 3 years for those screening positive and negative. (3) Characteristics, uptake and risk assessment results for hospital in-house domestic violence referrals compared with Camden Safety Net referrals from other sources. RESULTS: Of the 10,158 patients screened, 57.4% were female with a median age of 30 years. Overall, 7.1% reported ever-experiencing domestic violence, ranging from 5.7% in GUM to 29.4% in HIV services. People screening positive for domestic violence had higher rates of previous emergency department attendances (rate ratio (RR) 1.63, 95% CI 1.09 to 2.48), emergency inpatient admissions (RR 2.27, 95% CI 1.37 to 3.84) and day-case admissions (RR 2.03, 95% CI 1.23 to 3.43) than those screening negative. The 77 hospital referrals to the hospital-based domestic violence advisor during the study period were more likely to be taken up and to be classified as high risk than referrals from elsewhere. CONCLUSIONS: Selective screening for domestic violence in high-risk hospital clinic populations has the potential to identify affected patients and promote good uptake of referrals for in-house domestic violence support.

Endometrial carcinoma on continuous combined HRT: case report and literature review.

BACKGROUND: Continuous combined hormone replacement therapy (HRT) has been introduced in an attempt to increase patient compliance by eliminating withdrawal bleeding which is one of the most significant and troublesome side effects of sequential HRT. Moreover, when given on a daily basis, progestin is thought to be more protective against the development of endometrial carcinoma. CASE REPORT: We describe the case of a 59-year-old woman, diagnosed with endometrial carcinoma while on continuous combined HRT. Her last menstrual period was 7 years ago and she had been on HRT ever since. Initially, she tricycled her preparation using transdermal gel 17beta-estradiol 1.5 mg daily along with vaginal micronised progesterone 200 mg daily from day 1 to 12 every 3 months for the first 5 years and she had regular withdrawal bleeding. She was then moved on to continuous combined HRT (transdermal gel 17beta-estradiol 2.25 mg daily plus dydrogesterone 10 mg per os daily) and started to be amenorrhoeic. A routine transvaginal ultrasound showed an increased endometrial echo (10 mm). She was completely asymptomatic. Further investigations resulted in a report of a well differentiated grade II endometrial carcinoma with squamous differentiation. A review of literature confirms endometrial cancer to be rare while on continuous progesterone and difficulties posed in diagnosing it.